Many highly regarded hospitals in the U.S. routinely diagnose brain death without following the guidelines promulgated in 1995 by the American Academy of Neurology (AAN), according to a survey presented at the American Neurological Association (ANA) annual meeting (Kurt Samson, Neurology Today 11/6/07).Researchers at the Massachusetts General Hospital surveyed the top 50 neurology and neurosurgery departments nationwide; 82 percent responded. Results showed that “adherence to the AAN guidelines varied widely, leading to major differences in practice, which may have consequences for the determination of death and initiation of transplant procedures,” said Dr. David Greer.

Apnea testing was omitted by 27 percent; still more distressing is that many fail to even check for spontaneous respirations.

“We’re hoping to present a persuasive case for new standards,” said Dr. David Greer.

“In plain, straight talk,” writes Dr. Lawrence Huntoon, editor-in-chief of the Journal of American Physicians and Surgeons, “the survey indicates a high likelihood that some patients are being ‘harvested’ in some hospitals before they are dead! In hospitals with aggressive transplant programs (hospitals make a huge amount of money on transplant cases), making sure a patient is dead before going to the ‘harvesting suite’ may be viewed as a minor technicality/impediment.”

In another poster at the AAN conference, Dr. Eelco Wijdicks reported that the “physical deterioration of brain matter once referred to as ‘respirator brain’ has become an anomaly in today’s ‘modern transplant era’—where temperature and other variables of new cadavers must be carefully monitored and controlled to keep organs viable.”

In the past, he noted, patients had often been kept on respirators for weeks, and their brains [but apparently not their livers] had turned to liquid.

These days, microscopic analysis may be needed to detect the changes. “Variable neuronal loss was noted in the brain and brainstem samples, but total necrosis was rarely observed”—because of “earlier preservation of the brain and more efficient organ harvesting programs.”

“It’s just a matter of basic pathology that needs to be recognized in this era of transplantation,” said Dr. James Bernat, professor of neurology at Dartmouth.

Additional information:

• Brain death and organ transplantation

There’s a new kind of brokerage firm in our brave new world: agencies that assemble databases of young women and market their eggs to customers who want a baby and can’t produce one themselves.

Some offer photographs and information about hobbies, education, and religion, along with health screening, so customers can pick the “donor.” Some consider “donor shopping” for “designer babies” unethical, and match the donor on the basis of a few genetic traits.

The broker charges around $16,500, which includes the donor’s fee of $4,000 or more. A woman who has successfully “cycled” three or four times can command up to $8,000.

A donor must inject herself with fertility drugs every day for 6 weeks. Donor #8447 produced 16 eggs during one cycle. Some of the embryos that were created were implanted, and some frozen.

“I think it’s great,” she said. “Men have always been able to spread their genes. Now I can spread my genes” (Minneapolis Star-Tribune 10/22/07).

The outcome of these “miracles for sale” is not always happy. Some clients have held a newborn in their arms and said “I don’t feel attached to my child,” reported University of Minnesota psychologist Linda Hammer Burns. Or years after children are born, divorcing parents use the means of their conception as emotional weapons in bitter legal fights (ibid.).

An unasked question is how many years of her own potential fertility has donor #8447 sold? There is apparently no limit. Tests for infectious diseases that could be transmitted to surrogate or baby are among the few regulations governing egg and sperm donation in the U.S.

Infertile women who create frozen embryos tend to have a view of them that differs from that of donor #8447.

“Our data suggest that for most of the individuals who create embryos in hopes of having a baby, the preference is not that their remaining embryos have a chance at life, but rather that they be used in a way (research, and if not, simply destruction) that ensures that they do not,” write Anne Drapkin Lyerly of Duke University Medical Center and Ruth R. Faden of the Johns Hopkins Berman Institute of Bioethics (Science 2007;317:46-47).

More than half would donate their embryos for research, apparently believing that “scientific progress justifies the instrumental use of early human life.” Only around 20% would donate to another couple, suggesting that “there are deep responsibilities to one’s own embryos…that preclude allowing them to develop into children without the knowledge, participation, or love of those who created them.”

About 400,000 human embryos are currently cryopreserved.

Additional information:

• “Purchase of Human Eggs Creates Ethical Dilemma,” AAPS News of the Day 4/5/07
• AAPS Resolution Affirming the Sanctity of Human Life, 2003